Associations of maximal strength and muscular endurance test scores with cardiorespiratory fitness and body composition

The purpose of the present study was to assess the relationships between maximal strength and muscular endurance test scores additionally to previously widely studied measures of body composition and maximal aerobic capacity. 846 young men (25.5 ± 5.0 yrs) participated in the study. Maximal strength was measured using isometric bench press, leg extension and grip strength. Muscular endurance tests consisted of push-ups, sit-ups and repeated squats. An indirect graded cycle ergometer test was used to estimate maximal aerobic capacity (V(O2)max). Body composition was determined with bioelectrical impedance. Moreover, waist circumference (WC) and height were measured and body mass index (BMI) calculated. Maximal bench press was positively correlated with push-ups (r = 0.61, p < 0.001), grip strength (r = 0.34, p < 0.001) and sit-ups (r = 0.37, p < 0.001) while maximal leg extension force revealed only a weak positive correlation with repeated squats (r = 0.23, p < 0.001). However, moderate correlation between repeated squats and V(O2)max was found (r = 0.55, p < 0.001) In addition, BM and body fat correlated negatively with muscular endurance (r = -0.25 - -0.47, p < 0.001), while FFM and maximal isometric strength correlated positively (r = 0.36-0.44, p < 0.001). In conclusion, muscular endurance test scores were related to maximal aerobic capacity and body fat content, while fat free mass was associated with maximal strength test scores and thus is a major determinant for maximal strength. A contributive role of maximal strength to muscular endurance tests could be identified for the upper, but not the lower extremities. These findings suggest that push-up test is not only indicative of body fat content and maximal aerobic capacity but also maximal strength of upper body, whereas repeated squat test is mainly indicative of body fat content and maximal aerobic capacity, but not maximal strength of lower extremities.

Decreased disability is associated with improved perceived quality of life following spinal fusion

PURPOSE

To assess the disability and relationship between functional status and health related quality of life (HRQoL) in patients in the early recovery phase following spinal fusion.

METHODS

This is a prospective cohort study. Since 2008 data of spinal fusion patients have been collected prospectively in two Finnish hospitals. In August 2009, complete data of 173 patients were available. The measurement tool of disability was the Oswestry Disability Index (ODI) and it was also examined in the framework of International Classification of Functioning, Disability and Health (ICF) using body functions and structures, activities and participation components.

RESULTS

Preoperatively the mean total ODI was 45 (SD17) and mean (95% confidence interval) change to 3 months postoperatively was -19 (-22 to -17). When the ODI was linked to the ICF, there was a 55% improvement in the body structure and functions component and a 44% improvement in both the activities and the participation components. However, 25% of the patients still had the total ODI score over 40 three months postoperatively. Preoperatively, the mean (95% CI) Physical Component Summary Score (PCS) of the Short Form 36-questionnaire (SF-36) was 27 (26 to 28) and the mean Mental Component Summary Score (MCS) of SF-36 was 47 (45 to 49). Postoperatively the improvement was 9 (95% CI: 8 to 11) in PCS and 6 (95% CI: 4 to 7) in MCS (p < 0.001).

CONCLUSIONS

Spinal fusion is successful in the early recovery period in terms of reduction of pain and disability. The significant changes in the ODI were seen in all three components of the ICF model. In addition, improvement in functioning was significantly related to positive change in HRQoL. Still there is a subgroup of patients having marked disability needing more intensive rehabilitation and follow-ups.

Acute effects of cold pack on mechanical properties of the quadriceps muscle in healthy subjects

PURPOSE

To examine the effects of local cooling on mechanical properties of the quadriceps muscle in healthy subjects.

SUBJECTS

Thirty-nine healthy subjects (27 women, 12 men, mean age 39, range 20-62) volunteered.

METHODS

A cold gel pack was applied to the quadriceps muscle for 20 min. Properties were quantified by analyzing the frequency (tension), decrement (elasticity) and stiffness of damped oscillations and the compliance of the muscle before, immediately after and after 15-min after cooling.

RESULTS

The largest responses immediately after cooling were seen in the oscillation decrement parameter, 7.9 (3.7-12.1) %, and in the compliance parameter, -7.5 (-9.8 to -5.3) %. Responses in the oscillation frequency, 6.5 (2.3-10.6) %, and stiffness parameters, 4.0 (0.8-7.1) %, were also statistically significant. The compliance still showed a -6.1 (-7.7 to -4.5) % decrease after the 15 min recovery phase, while no remaining alteration was found in the oscillation parameters.

CONCLUSION

The quadriceps muscle became tenser, stiffer, and less elastic as a result of cooling, and the mechanical properties were not fully recovered after 15 min. Careful warming-up is suggested after cooling to enable normalization of mechanical properties of the muscle and to avoid injuries.

Randomized controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol

Background

Lumbar spine fusion (LSF) effectively decreases pain and disability in specific spinal disorders; however, the disability rate following surgery remains high. This, combined with the fact that in Western countries the number of LSF surgeries is increasing rapidly it is important to develop rehabilitation interventions that improve outcomes.

Methods/design

In the present RCT-study we aim to assess the effectiveness of a combined back-specific and aerobic exercise intervention for patients after LSF surgery. One hundred patients will be randomly allocated to a 12-month exercise intervention arm or a usual care arm. The exercise intervention will start three months after surgery and consist of six individual guidance sessions with a physiotherapist and a home-based exercise program. The primary outcome measures are low back pain, lower extremity pain, disability and quality of life. Secondary outcomes are back function and kinesiophobia. Exercise adherence will also be evaluated. The outcome measurements will be assessed at baseline (3 months postoperatively), at the end of the exercise intervention period (15 months postoperatively), and after a 1-year follow-up.

Discussion

The present RCT will evaluate the effectiveness of a long-term rehabilitation program after LSF. To our knowledge this will be the first study to evaluate a combination of strength training, control of the neutral lumbar spine position and aerobic training principles in rehabilitation after LSF.

Trial registration

ClinicalTrials.gov Identifier NCT00834015

Relationships between depressive symptoms and self-reported unintentional injuries: the cross-sectional population-based FIN-D2D survey

Background

There is a lack of knowledge on the influence of different levels of physical activity (PA) on unintentional injuries among those with depressive symptoms (DS). The aim of this study was to evaluate the relationship between PA categories and unintentional injuries among participants with and without DS based on a cross-sectional population–based FIN-D2D survey conducted in 2007.

Methods

Out of 4500, 2682 participants (60%) aged 45–74 years attended in this study. The unintentional injuries over the past year were captured in a questionnaire. DS were determined with the Beck Depression Inventory (≥ 10 points) and PA with the International Physical Activity Questionnaire. The statistical significance between DS and unintentional injury categories was evaluated by using t-test, chi-square test, or permutation test, analysis of covariance, or regression models. The factors related to unintentional injuries were estimated by univariate and multivariate logistic regression models.

Results

The proportion of subjects with unintentional injuries was higher among those with DS (17%) compared to those without DS (10%) (age- and gender-adjusted p = 0.023). The median (range) number of activity-loss days after injury was 22 (0–365) in participants with DS and 7 (0–120) in participants without DS ( p = 0.009). The percentage of subjects with unintentional injuries was not significantly different between PA categories in participants with DS and without DS. A stepwise multivariate logistic regression analysis showed that DS, functional ability, and musculoskeletal diseases were related to unintentional injuries.

Conclusions

PA level was not related to unintentional injuries, whereas those with DS had a higher prevalence of unintentional injuries and prolonged activity-loss after injury. These results underline the importance of injury prevention, especially among those who have DS and additional risk factors.

The early changes in trunk muscle strength and disability following lumbar spine fusion

PURPOSE

To analyze trunk muscle function pre- and postoperatively in patients undergoing lumbar spine fusion. Associations between changes in trunk muscle strength and disability were also studied.

METHOD

A total of 114 patients undergoing lumbar spine fusion participated in the study. The flexion and extension strength of the trunk was measured preoperatively and 3 months after surgery using a strain-gauge dynamometer. Disability and pain during the past week was evaluated with the Oswestry disability index (ODI) and visual analog scale (VAS), respectively.

RESULTS

Preoperative trunk extension and flexion strength levels were 319 N and 436 N in males, respectively, and 160 N and 214 N in females, respectively. In females 3 months postoperatively, the trunk extension strength increased by 39 N (p < 0.001) and flexion by 38N (p < 0.001), whereas it remained unchanged in males. The preoperative extension/flexion strength ratio was 0.79 in females and 0.76 in males. Three months postoperatively, the strength ratio decreased to 0.66 in males (p = 0.02). The mean ODI improved by 47% and back pain decreased by 65% (both p < 0.001). The changes in the ODI correlated with changes in trunk extension (r = -0.38) and flexion (r = -0.43) strength.

CONCLUSIONS

Patients undergoing lumbar spine fusion had low trunk muscle strength and strength imbalance. Back fusion surgery leads to considerable relief of pain and disability, but patients still have low trunk extension and flexion strength levels 3 months postoperatively. Therefore, there is need for a proper progressive strength training protocols to normalize back function.

Effects of prolonged and maintenance strength training on force production, walking, and balance in aging women and men

To examine effects of 21-week twice/week strength training (ST) period followed by an additional 21-week twice or once/week ST period on force production, walking and balance in aging people. Seventy-two women (58 ± 7 years; W) and 63 (58 ± 6 years) men (M) were randomized for the first 21-week ST period: STW and STM, control (C) CW and CM. Training participants were randomized for the second 21-week ST period: once/week STWx1 and STMx1, twice/week STWx2 and STMx2. LegPress, isometric leg extension rate of force development (RFD), walking time, and balance. First 21-week ST period: leg press, RFD, balance, and walking improved significantly in STW and STM. Second 21-week ST period: leg press first increased in STMx1 and STMx2, and then decreased to the level of 21 weeks in STMx2 and remained unchanged in STWx2 and decreased in STWx1 and STMx1. Walking and balance improved significantly in STWx1 and STWx2. A progressive 21-week ST period twice/week in aging people can lead to large improvements in maximal strength, walking time, and balance in both genders. A further strength training period with the same amount of training may maintain the strength gains, whereas balance and walking may be maintained with less training.

Association of neck pain, disability and neck pain during maximal effort with neck muscle strength and range of movement in women with chronic non-specific neck pain

Several studies have reported lower neck muscle strength in patients with chronic neck pain compared to healthy controls. The aim of the present study was to evaluate the association between the severity of neck pain and disability with neck strength and range of movement in women suffering from chronic neck pain. One hundred and seventy-nine female office workers with chronic neck pain were selected to the study. The outcome was assessed by the self-rating questionnaires on neck pain (visual analogue scale, Vernon's disability index, Neck pain and disability index) and by measures of the passive range of movement (ROM) and maximal isometric neck muscle strength. No statistically significant correlation was found between perceived neck pain and the disability indices and the maximal isometric neck strength and ROM measures. However, the pain values reported during the strength tests were inversely correlated with the results of strength tests (r=-0.24 to -0.46), showing that pain was associated with decreased force production. About two-thirds of the patients felt pain during test efforts. Pain may prevent full effort during strength tests and hence the production of maximal force. Thus in patients with chronic neck pain the results do not always describe true maximal strength, but rather the patients' ability to bear strain, which may be considerably influenced by their painful condition. The results of the present study suggest that rehabilitation in cases of chronic neck pain should aim at raising tolerance to mechanical strain.

Effect of long-term neck muscle training on pressure pain threshold: A randomized controlled trial

Muscle tenderness has been measured in several studies to evaluate effectiveness of treatment methods, but only short-term results have been reported so far. The aim of the present study was to evaluate the long-term effects of two different muscle training methods on the pressure pain threshold of neck muscles in women with neck pain. Altogether 180 woman with chronic, non-specific neck pain were randomized into three groups: neck muscle endurance training, neck muscle strength training and control groups. The main outcome measures included pressure pain threshold measurement at six muscle sites and on the sternum. Neck pain was assessed by a visual analogue scale (VAS). At the 12-month follow-up statistically significantly higher pressure pain threshold values were obtained in both training groups at all muscle sites compared to the baseline, while no significant change occurred in the controls. Significantly higher changes in pressure pain threshold were detected at all six sites in the strength training group and at four out of six sites in the endurance training group compared to the control group. This is the first study to show an increase in pressure pain thresholds as a result of long-term muscle training. A decrease in neck pain was associated with reduced pressure pain sensitivity in neck muscles, showing that the pressure pain threshold may be a useful outcome measure of the effectiveness of neck muscle rehabilitation.

[Referrals of knee osteoarthritis patients to orthopedic surgery]

BACKGROUND

Due to large volume of knee osteoarthritis referrals and increasing waiting times, the contents of referrals and patient's pathways were analyzed in the Jyväskylä Central Hospital.

METHODS

The referral contents of 171 knee osteoarthritis patients referred to the orthopedic outpatient clinic were screened, and the post-referral treatment decisions were pulled from the medical records.

OUTCOME

Most of the referrals had information about the diagnosis (90%), pain (88%) and symptom duration (80%). The least frequently mentioned were BMI (3%) and the implementation of conservative treatment (7%). During the specialist visit following the referral, 62% of the patients ended up in operative and 38% in conservative treatment. There was no connection between the referral contents and the line of treatment chosen.

CONCLUSIONS

Conservative treatment of knee osteoarthritis should be optimized prior to referral to specialist care.

Influence of different DXA acquisition modes on monitoring the changes in bone mineral density after hip resurfacing arthroplasty

Dual-energy X-ray absorptiometry (DXA) is a technique enabling the measurement of bone mineral density (BMD) around prostheses after hip resurfacing arthroplasty (HRA). In this study, we evaluated the consistency of different DXA acquisition modes with 33 patients who had undergone HRA. Patients were scanned with DXA immediately after surgery and at 3-, 6-, and 12-mo time points. All the patients were scanned with dual femur and orthopedic hip acquisition modes and analyzed using 10-region ROI model. With both acquisition modes, a statistically significant decrease (p<0.05, Wilcoxon's test) in BMD at 3mo was revealed in 3 ROIs, located to upper and lateral upper femur. Both acquisition modes detected similarly (p<0.01) preservation of the femoral bone stock within 12mo in all but 1 ROI. The applied acquisition protocols involved the use of different footplates for hip fixation. Because the differences between acquisition modes ranged between +1.6% and -7.1% and the reproducibility of BMD values can vary by as much as 28% due to hip rotation, it is proposed that both dual femur and orthopedic hip acquisition modes can be used to monitor the changes in BMD after HRA. However, the same hip rotation is recommended for all DXA measurements.

Bone mineral density of the proximal femur after hip resurfacing arthroplasty: 1-year follow-up study

Background

Hip resurfacing arthroplasty (HRA) is considered a bone-preserving procedure and may eliminate proximal femoral stress shielding and osteolysis. However, in addition to implant-related stress-shielding factors, various patient-related factors may also have an effect on bone mineral density (BMD) of the proximal femur in patients with HRA. Thus, we studied the effects of stem-neck angle, demographic variables, and physical functioning on the BMD of the proximal femur in a one-year follow-up.

Methods

Thirty three patients (9 females and 24 males) with a mean (SD) age of 55 (9) years were included in the study. BMD was measured two days and 3, 6, and 12 months postoperatively and 10 regions of interest (ROI) were used. Stem-neck angle was analyzed from anteroposterior radiographs.

Results

Three months postoperatively, BMD decreased in six out of 10 regions of interest (ROI) on the side operated on and in one ROI on the control side (p < 0.05) compared to the second postoperative day. At 12 months, BMD had increased in 7 ROIs on the operated side and one ROI on the control side (all p < 0.001). Correlation was found between the stem-neck angle and BMD in ROIs 2, 3, 7, and 9 (r = 0.36 - 0.61). In multiple regression analysis, stem-neck angle, age, sex, body mass index, and walking distance did not explain the BMD changes.

Conclusions

After an early drop, the BMD of the upper femur was restored and even exceeded the preoperative level at one year follow-up. From a clinical standpoint, the changes in BMD in these HRA patients could not be explained by stem-neck angle or patient related factors.

Load carrying walking test and its relationships to endurance and neuromuscular capabilities in women and men of different ages

The aim of this study was to examine load carrying walking test (TMload) performance on the treadmill and its associations to endurance and neuromuscular capabilities in women and men of different ages. Sixty participants (aged 28 to 71 years) were divided into young, middle-aged and old groups of both genders. Clinical stress test was performed by stationary cycle ergometer (CEload). Peak oxygen uptake (VO2peak), heart rate and lactate concentration were measured using maximal TMload test. Isometric strength and EMG-activity of upper and lower extremities were measured before and after TMload. VO2peak of TMload correlated significantly with TMload exercise time (ET) in all other groups (r=0.67 to 0.91 and p ≤ 0.05 to p<0.001) except old men. Leg extension force decreased (p ≤ 0.05 to p<0.001) after TMload in all groups, grip force in young groups (p ≤ 0.05), while plantar flexion force and all EMGs remained unchanged. In men VO2peak explained 81% and in women VO2peak and age explained 87% of the total variation of the TMload ET. In conclusion, ET of TMload is associated with high VO2peak, but not with muscle strength or its changes during the loading. The present load carrying walking test may be used for testing workers with heavy loading in their occupation or in rehabilitation purposes. Further research is needed to examine in more detailed the loading model of the present study as well as the effects of different types of training on load carrying performance.

[Implementation of preoperative physiotherapy and recovery after shoulder impingement surgery]

BACKGROUND

Subacromial impingement syndrome is a common orthopedic condition.

METHODS

Patients operated due to shoulder impingement (n=104) were sent a questionnaire inquiring rehabilitation procedures before and after surgery, pain and shoulder function.

RESULTS

Response rate was 68%, mean age of the patients was 53 years. Before surgery, 50% of the patients had received physiotherapy. The symptoms disappeared after surgery in the majority of the patients. However, 13% of the patients had significant shoulder pain (VAS over 30 mm) one year postoperatively and 15% had considerable functional deficit.

CONCLUSIONS

To avoid unnecessary operations for shoulder impingement proper conservative treatment must be provided before surgery.

Sustained improvement of health-related quality of life in patients with early rheumatoid arthritis: a ten-year follow-up study

OBJECTIVES

To assess long-term impact of RA on the HR-QoL in a cohort of working-age patients with early disease treated by a multidisciplinary team including early and active use of disease-modifying anti-rheumatic drugs (DMARDs).

METHODS

Fifty-five consecutive patients with RA who were naïve to DMARDs and glucocorticoids were assessed at baseline and at 6 months, 1, 2, 5 and 10 years. HR-QoL, disease activity, function, and joint destruction of hands and feet were assessed by using the Nottingham Health Profile (NHP) instrument, the 28-joint based Disease Activity Score (DAS28), the Health Assessment Questionnaire (HAQ), and the Larsen scores, respectively. GEE (generalised estimation equations)-method was used to evaluate longitudinal relationships between the HR-QoL changes and other variables.

RESULTS

All NHP dimensions except social isolation improved significantly during the first six months and remained favourable up to 10 years. The most prominent improvements were seen in the dimensions for pain and emotional reaction (p<0.001). In longitudinal evaluation statistically significant associations (p<0.001) were found between the DAS28 and the NHP dimensions for pain, energy and emotional reaction, and between the HAQ and the NHP dimensions for pain, energy and mobility. The extent of joint damage had no statistically significant associations to the six dimensions of the NHP instrument.

CONCLUSIONS

Early improvements in HR-QoL carried over the ten-year follow-up in patients with recent-onset RA treated with a multidisciplinary strategy including early and active DMARD therapy. HR-QoL changes were longitudinally associated especially with disease activity and function.

Leisure-time physical activity and metabolic syndrome plus depressive symptoms in the FIN-D2D survey

OBJECTIVE

To examine the association between leisure-time physical activity (LTPA) and simultaneous presence of metabolic syndrome (MetS) and depressive symptoms (DS) based on a population-based FIN-D2D cross-sectional survey conducted in 2007.

METHODS

4500 randomly selected Finnish men and women aged 45-74 years were initially enrolled; 2868 (64%) attended a health examination. Participants with complete information (n=2778) were grouped into three LTPA categories: low, moderate and high. MetS was based on the National Cholesterol Education Program criteria and DS on the Beck Depression Inventory (≥10 points).

RESULTS

The prevalence of MetS and DS were 53% and 15%, respectively; the prevalence of simultaneous MetS and DS was 10%. The proportion of subjects with MetS, DS and simultaneous presence of MetS and DS increased with decreasing LTPA (p<0.001). On multivariate ordered analysis, LTPA was related to education years, household income, smoking, and the presence of MetS only, DS only and simultaneous MetS and DS.

CONCLUSION

The prevalence of simultaneous MetS and DS was higher in participants with low LTPA compared with participants with high LTPA. Furthermore, LTPA level was associated with socioeconomic status and other health related outcomes, outlining the importance of LTPA as part of the general health promotion.